Kids Ministry - Parent Forms

Registration

Medical Release

Van Permission

info Please complete all fields marked with * to register your child for Kids Ministry.

child_care Child Information

First Name *

Last Name *

Date of Birth *

Home Address *

City

State

ZIP

Cell Phone

family_restroom Parent / Guardian

Parent/Guardian 1 Name *

Phone *

Email *

Parent/Guardian 2 Name

Phone

medical_services Medical Information

Known Medical Conditions

Allergies

Emergency Contact (other than parents)

warning_amber Important: Please Complete All Required Forms

Before submitting, please make sure you have filled out and submitted the Medical Release form and the Van Permission form (if your child will ride the church van). Use the tabs above to switch between forms.

I have completed and submitted the Medical Release form. *

I have completed and submitted the Van Permission form, OR my child will not be riding the church van. *

I confirm that all information provided is accurate and I authorize Gladwin AG Kids Ministry to use this information for the care and safety of my child. *

warning_amber This medical release authorizes emergency medical treatment for your child while in the care of Kids Ministry.

medical_services Medical Release

Child's First Name *

Child's Last Name *

Date of Birth *

Known Medical Conditions *

Current Medications

Allergies *

Doctor's Name

Doctor's Phone

Insurance Provider

Policy Number

MEDICAL RELEASE AUTHORIZATION

I, the undersigned parent/legal guardian, hereby authorize Gladwin Assembly of God Kids Ministry and its designated representatives to consent to any medical treatment, including but not limited to X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to my child under the general or special supervision of any physician, surgeon, dentist, or other medical professional licensed under the provisions of the Medical Practice Act.

This authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of the aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician, in the exercise of his/her best judgment, may deem advisable.

This authorization shall remain effective until revoked in writing by the undersigned parent/legal guardian.

I have read and agree to the Medical Release Authorization above. I authorize emergency medical treatment for my child. *

Parent/Guardian Name (Print) *

Digital Signature *

Tap/click and sign here

Date

directions_bus This form grants permission for your child to ride in the church van to and from services and events.

My child will NOT be riding the church van.
Check this box if van transportation is not needed, then return to the Registration tab to submit.

directions_bus Van Riding Permission

Child's First Name *

Child's Last Name *

Date of Birth *

Pickup Address *

Authorized Pickup Contacts

VAN RIDING PERMISSION

I, the undersigned parent/legal guardian, hereby give permission for my child to ride in the Gladwin Assembly of God church van/bus to and from church services, church-sponsored events, and activities.

I understand that:
- All passengers are required to wear seatbelts at all times while the vehicle is in motion.
- The church maintains appropriate insurance coverage for the vehicle and passengers.
- Drivers are screened and approved by church leadership.
- My child will be supervised by approved volunteers during transport.

I release Gladwin Assembly of God, its staff, volunteers, and drivers from any liability for injury or damage that may occur during transportation, except in cases of gross negligence.

This permission shall remain in effect for the current ministry year unless revoked in writing.

I have read and agree to the Van Riding Permission above. I give permission for my child to ride in the church van. *

I acknowledge that my child is required to wear a seatbelt at all times while riding in the church van. *

Parent/Guardian Name (Print) *

Digital Signature *

Tap/click and sign here

Date

check_circle

Form Submitted!

Thank you! Your form has been submitted for review. A ministry administrator will review and approve your submission.